D34 LUNG TRANSPLANT AND DRUG INDUCED LUNG DISEASE: CASE REPORTS / Thematic Poster Session / Wednesday, May 23/9:15 AM-3:30 PM / Area J (Hall A-B2, Ground Level) - San Diego Convention Center
Pulmonary Toxicity Due to 5-Fluorouracil (5-FU) Manifested as Diffuse Alveolar Hemorrhage: Case Report L. Fernandez1, A. Dominguez2, W. Martinez3, F. Sanabria3, C. S. Leib4, Biomedical Research Group in Thorax; 1Interventional Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 2Internal Medicine Resident, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 3Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia, 4Medical Research, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia. Corresponding author's email:
[email protected] INTRODUCTION Radiotherapy and chemotherapy with 5-FU is the standard treatment in colorectal cancer. Adverse effects of 5-FU al related to its metabolites and include myelosupression, neurotoxicity, mucositis, gastrointestinal and cardiac alterations. There are few reports of pulmonary toxicity after treatment with 5-FU. We experienced a case of pulmonary toxicity manifested as diffuse alveolar hemorrhage secondary to 5-FU therapy in a patient with colorectal cancer. CASE REPORT A 71 year-old female, with previous history of high blood pressure, diabetes and coronary artery disease with revascularization and stent placement, had a diagnosis of a locally advanced EIIIB colorectal cancer, treated with radiotherapy and chemotherapy with 5-FU boluses. 12 days after initiation of treatment the patient developed diarrhea, dyspnea, hemoptysis, and higher oxygen demands; EKG and troponins were negative. A computed tomography angiography of the chest demonstrated multiple ground-glass opacities, no areas of consolidation and no evidence of a pulmonary embolism. He presented a 2g/dL decrease in the hemoglobin level. Suspecting a diffuse alveolar hemorrhage, a bronchoscopy is performed showing blood remains all over the bronchial tree with evident hemorrhagic bronchoalveolar lavage. Cytology described positive hemosiderophages; negative microscopy and cultures. An adverse effect of the 5-FU is suspected, treatment is suspended and the patient is taken to the ICU for supportive care. The patient´s condition evolves poorly, presenting with vasodilatory shock, respiratory failure, severe mucositis and medullary aplasia. He undergoes invasive ventilatory and hemodynamic support, is started on antibiotics in spite of negative cultures. Subsequently, the patient is extubated and taken of hemodynamic support, with hemoglobin stabilization and complete resolution of the pulmonary compromise. DISCUSSION The Diagnosis of chemotherapy induced pulmonary toxicity is based on clinical suspicion and dismissal of other causes such as opportunistic infections, heart failure and progression of the oncological disease. Invasive procedures such as a bronchoalveolar lavage and biopsy may be necessary for confirmation. 5-FU- mediated toxicity is related to its catabolic pathway; up to 80% of the drug is metabolized by the dihydropyrimidine dehydrogenase enzyme. Severe toxicity has been described with partial or total enzyme deficiency, and can be present in 3-5% of the population. Pulmonary compromise is rare, it usually presents as interstitial pneumonia; however diffuse alveolar damage and hemorrhage have also been described.
This abstract is funded by: none Am J Respir Crit Care Med 2018;197:A6577 Internet address: www.atsjournals.org
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